A cohort study of early neurological consultation by telemedicine on the care of neurological inpatients

Objectives: To find out the effect of early neurological consultation using a real time video link on the care of patients with neurological symptoms admitted to hospitals without neurologists on site. Methods: A cohort study was performed in two small rural hospitals: Tyrone County Hospital (TCH), Omagh, and Erne Hospital, Enniskillen. All patients over 12 years of age who had been admitted because of neurological symptoms, over a 24 week period, to either hospital were studied. Patients admitted to TCH, in addition to receiving usual care, were offered a neurological consultation with a neurologist 120 km away at the Neurology Department of the Royal Victoria Hospital, Belfast, using a real time video link. The main outcome measure was length of hospital stay; change of diagnosis, mortality at 3 months, inpatient investigation, and transfer rate and use of healthcare resources within 3 months of admission were also studied. Results: Hospital stay was significantly shorter for those admitted to TCH (hazard ratio 1.13; approximate 95% Cl 1.003 to 1.282; p = 0.045). No patients diagnosed by the neurologist using the video link subsequently had their diagnosis changed at follow up. There was no difference in overall mortality between the groups. There were no differences in the use of inpatient hospital resources and medical services in the follow up period between TCH and Erne patients. Conclusions: Early neurological assessment reduces hospital stay for patients with neurological conditions outside of neurological centres. This can be achieved safely at a distance using a real time video link.

A Complementary Economy? National Markets and International Product in Early Australian Theatre Managements

The international circulation of commercial theatre in the early twentieth century was driven not only from the centres of Great Britain and the USA, but by the specific enterprise and habitus of managers in ‘complementary’ production sites such as Australia, South Africa, and New Zealand. The activity of this period suggests a de-centred competitive trade in theatrical commodities – whether performers, scripts, or productions – wherein the perceived entertainment preferences and geographies of non-metropolitan centres were formative of international enterprise. The major producers were linked in complex bonds of partnerships, family, or common experience which crossed the globe. The fractures and commonalities displayed in the partnerships of James Cassius Williamson and George Musgrove, which came to dominate and shape the fortunes of the Australian industry for much of the century, indicate the contradictory commercial and artistic pressures bearing upon entrepreneurs seeking to provide high-quality entertainment and form advantageous combinations in competition with other local and international managements. Clarke, Meynell and Gunn mounted just such spirited competition from 1906 to 1911, and their story demonstrates both the opportunities and the centralizing logic bearing upon local managements shopping and dealing in a global market. The author, Veronica Kelly, works at the University of Queensland. She is presently undertaking a study of commercial stars and managements in late nineteenth- and early twentieth-century Australia, with a focus on the star performer as model of history, gender, and nation.

The pathogenesis of migraine - 17th to early 20th Century understandings

The modern understanding of the pathogenesis of migraine, based on the concept that it is a neurovascular disorder, is often thought to have emerged from the work of Harold Wolff in the period 1932-1962. However, over the preceding 300 years, from William Harvey onwards, various hypotheses of the pathogenesis of migraine had been proposed, a few bearing reasonably strong resemblances to Wolff's ideas, though based on less adequate evidence. Many of these earlier hypotheses regarded migraine either primarily as a vascular (e.g., Willis, Wepfer, Latham) or as a neural disorder (e.g., Harvey, Lieving and his 'nerve storms'). There were also variations around these two major themes and in the 19th Century a number of neurovascufar type hypotheses emerged assigning a major role in migraine pathogenesis to the autonomic nervous system. In addition, during the three centuries there were a number of other hypotheses based on different postulated pathogenic mechanisms, some quite ingenious, which had relatively brief vogues. No hypothesis has yet proved capable of explaining all the features of migraine satisfactorily. (c) 2005 Elsevier Ltd. All rights reserved.

Alpha B-crystallin, a new independent marker for poor prognosis in head and neck cancer

Objectives. Gene expression profiling has provided many insights into tumor progression but translation to clinical practice has been limited. We have previously identified a list of potential markers by the differences of expression profiling of seven matched head and neck cancer (HNSCC) tumors with autologous normal oral mucosa (NOM). Alpha B-crystallin (CRYAB) was in the top 5% of genes identified with statistically significant differences in expression between tumor and NOM at the mRNA level. The objective was to confirm this in routine paraffin sections at the protein level. Study Design: The level of alpha B-crystallin was determined in tumors of 62 HNSCC patients whose prognosis was known for 5 years. Methods. Immunohistochemical detection of alpha B-crystallin expression was performed on HNSCC paraffin sections. Results. Univariate survival analysis identified lack of alpha B-crystallin staining as an independent prognostic marker for disease-free interval (P < 0.001) and overall survival (P < 0.002) of HNSCC patients over the 5-year observation period. Notably, all 13 patients (100%), including 5 patients with nodal disease whose tumors lacked alpha B-crystallin had no recurrences (P < 0.001). Nineteen of 27 node-negative patients stained positive for alpha B-crystallin and seven of the 19 (36.8%) had recurrences. Conclusion: Presence or absence of expression of alpha B-crystallin was a powerful marker for prognosis in this series of patients.

The Runx1 transcription factor controls CSF-1-dependent and -independent growth and survival of macrophages

Gene translocations that repress the function of the Runx1 transcription factor play a critical role in the development of myeloid leukemia. In this report, we demonstrate that Runx1 precisely regulates c-fms (CSF-1 receptor) gene expression. Runx1 controlled expression by binding to multiple sites within the mouse c-fms gene, allowing interaction between promoter and downstream enhancer elements. The runx1 and c-fms genes showed an identical pattern of expression in mature macrophages. Runx1 expression was repressed in CSF-1 stimulated, proliferating bone marrow-derived macrophages (BMM) and significantly increased in quiescent, CSF-1 starved cells. The RAW264.7 and Mono-Mac-6, macrophage-like cell lines expressed low levels of Runx1 and both showed growth arrest and cell death with ectopic expression of Runx1. The EM-3 cell line, which represents an early myeloid progenitor cell line, showed growth arrest with Runx1 expression in the absence of any detectable changes in cell differentiation. These findings suggest that Runx1 regulates growth and survival of myeloid cells and provide a novel insight into the role of Runx family gene translocations in leukemogenesis.

The effect of admission physiological variables on 30 day outcome after stroke

Introduction. Potentially modifiable physiological variables may influence stroke prognosis but their independence from modifiable factors remains unclear. Methods. Admission physiological measures (blood pressure, heart rate, temperature and blood glucose) and other unmodifiable factors were recorded from patients presenting within 48 hours of stroke. These variables were compared with the outcomes of death and death or dependency at 30 days in multivariate statistical models. Results. In the 186 patients included in the study, age, atrial fibrillation and the National Institutes of Health Stroke Score were identified as unmodifiable factors independently associated with death and death or dependency. After adjusting for these factors, none of the physiological variables were independently associated with death, while only diastolic blood pressure (DBP) >= 90 mmHg was associated with death or dependency at 30 days (p = 0.02). Conclusions. Except for elevated DBP, we found no independent associations between admission physiology and outcome at 30 days in an unselected stroke cohort. Future studies should look for associations in subgroups, or by analysing serial changes in physiology during the early post-stroke period.

Looking beyond the negatives: A time period analysis of positive cognitions, negative cognitions, and working alliance in cognitive-behavior therapy for panic disorder

Time period analysis was used in an international sample of clients ( N = 106) to demonstrate that cognitive - behavioral therapy (CBT) for panic disorder is associated with specific changes in both negative and positive cognitions during the treatment period. In the first 6 weeks of the treatment phase, working alliance failed to predict changes in panic severity, whereas changes in panic self-efficacy and catastrophic misinterpretation of bodily sensations predicted rapid symptom relief. In the last 6 weeks of treatment, higher doses of CBT were associated with further changes in positive and negative cognitions. The findings can be interpreted as suggesting that the role of the working alliance in CBT for panic disorder is to facilitate cognitive change.

The association between early minor motor difficulties in extreme low birth weight infants and school age attentional difficulties

Introduction: Extremely premature infants of normal intellectual ability have an increased prevalence of motor and attentional difficulties. Knowledge of the relationship between early motor difficulties and measures of attention at school age would enhance understanding of these developmental pathways, their interrelationship and opportunities for intervention. Objective: This study examines whether an association exists between early findings of minor motor difficulties and school age clinical and psychometric measures of attention. Methodology: 45/60 eligible ELBW(1000 g) or preterm (< 27/40 gestation) infants born at the Mater Mother's Hospital were assessed at 12 and 24 months for minor motor deficits (using NSMDA) and at 7-9 years for attention, using clinical (Conners and Du Paul Rating Scales) and psychometric (assessing attention span, selective and divided attention) measures. Results: NSMDA at 12 months was only associated with the psychometric measures of verbal attention span. It was not associated with later clinical measures of attention. NSMDA at 24months was strongly associated with specific clinical measures of attention at school age, independent of biological and social factors. It was not associated with psychometric measures of attention. Conclusion: The major finding of this study is that motor difficulties in ELBW infants at 2 years are associated with later clinical measures of attention. Possible mechanisms underlying this relationship are considered. Crown Copyright (c) 2005 Published by Elsevier Ireland Ltd. All rights reserved.

Changes in use of disease-modifying anti-rheumatic drugs in Australia over the period 1992-2004

Purpose Evidence is growing that early use of disease-modifying anti-rheumatic drugs (DMARDs) and combinations of these drugs provide optimal care for people with rheumatoid arthirits. The aim of this study was to describe objectively the pattern of consumption of DMARDs in the Australian community (community-based prescribing, specialist and general practitioner) 1992-2004, and to compare this with prescribing patterns reported in other countries. Method Dispensing statistics from the Pharmaceutical Benefit Scheme (PBS-Australia's universal prescription subsidy scheme) were analysed and temporal trends evaluated. Drug consumption was calculated as the number of dispensed defined daily doses (DDD)/1000 inhabitants/day (WHO ATC/DDD classification 2005). Results The consumption of DMARDs in the Australian community increased steadily from 2.6 DDD/1000 inhabitants/ day in 1992 to 5.5 DDD/1000 inhabitants/day. Over the period 1992-2004, methotrexate (MTX) was the most commonly used DMARD (from 0.6 to 3.0 DDD/1000 inhabitants/day). Consumption of gold (parentcral and oral) and penicillamine declined during this time. The inclusion of leflunomide on the PBS in 2000 contributed to the increase in DMARD usage. Conclusion Use of DMARDs within the Australian community has increased in recent years, coinciding with the change in guidelines for therapy for rheumatoid arthritis (RA) to earlier use of DMARDs and the more common use of combinations. This study used DDD methodology to quantify trends for DMARD consumption and these trends are broadly consistent with international prescribing patterns assessed using different methodologies. Copyright (c) 2006 John Wiley & Sons, Ltd.

Early and mid Holocene tool-use and processing of taro (Colocasia esculenta), yam (Dioscorea sp.) and other plants at Kuk Swamp in the highlands of Papua New Guinea

Recent multidisciplinary investigations document an independent emergence of agriculture at Kuk Swamp in the highlands of Papua New Guinea. In this paper we report preliminary usewear analysis and details of prehistoric use of stone tools for processing starchy food and other plants at Kuk Swamp. Morphological diagnostics for starch granules are reported for two potentially significant economic species, taro (Colocasia esculenta) and yam (Dioscorea sp.), following comparisons between prehistoric and botanical reference specimens. Usewear and residue analyses of starch granules indicate that both these species were processed on the wetland margin during the early and mid Holocene. We argue that processing of taro and yam commences by at least 10,200 calibrated years before present (cal BP), although the taro and yam starch granules do not permit us to distinguish between wild or cultivated forms. From at least 6950 to 6440 cal BP the processing of taro, yam and other plants indicates that they are likely to have been integrated into cultivation practices on the wetland edge.

How can experience in clinical and community settings contribute to early medical education? A BEME systematic review

Review date: Review period January 1992-December 2001. Final analysis July 2004-January 2005. Background and review context: There has been no rigorous systematic review of the outcomes of early exposure to clinical and community settings in medical education. Objectives of review: (1) Identify published empirical evidence of the effects of early experience in medical education, analyse it, and synthesize conclusions from it. (2) Identify the strengths and limitations of the research effort to date, and identify objectives for future research. Search strategy: Ovid search of. BEI, ERIC, Medline, CIATAHL and EMBASE Additional electronic searches of: Psychinfo, Timelit, EBM reviews, SIGLE, and the Cochrane databases. Hand-searches of: Medical Education, Medical Teacher, Academic Medicine, Teaching and Learning in Medicine, Advances in Health Sciences Education, Journal of Educational Psychology. Criteria: Definitions: Experience: Authentic (real as opposed to simulated) human contact in a social or clinical context that enhances learning of health, illness and/or disease, and the role of the health professional. Early: What would traditionally have been regarded as the preclinical phase, usually the first 2 years. Inclusions: All empirical studies (verifiable, observational data) of early experience in the basic education of health professionals, whatever their design or methodology, including papers not in English. Evidence from other health care professions that could be applied to medicine was included. Exclusions: Not empirical; not early; post-basic; simulated rather than 'authentic' experience. Data collection: Careful validation of selection processes. Coding by two reviewers onto an extensively modified version of the standard BEME coding sheet. Accumulation into an Access database. Secondary coding and synthesis of an interpretation. Headline results: A total of 73 studies met the selection criteria and yielded 277 educational outcomes; 116 of those outcomes (from 38 studies) were rated strong and important enough to include in a narrative synthesis of results; 76% of those outcomes were from descriptive studies and 24% from comparative studies. Early experience motivated and satisfied students of the health professions and helped them acclimatize to clinical environments, develop professionally, interact with patients with more confidence and less stress, develop self-reflection and appraisal skill, and develop a professional identity. It strengthened their learning and made it more real and relevant to clinical practice. It helped students learn about the structure and function of the healthcare system, and about preventive care and the role of health professionals. It supported the learning of both biomedical and behavioural/social sciences and helped students acquire communication and basic clinical skills. There were outcomes for beneficiaries other than students, including teachers, patients, populations, organizations and specialties. Early experience increased recruitment to primary care/rural medical practice, though mainly in US studies which introduced it for that specific purpose as part of a complex intervention. Conclusions: Early experience helps medical students socialize to their chosen profession. It. helps them acquire a range of subject matter and makes their learning more real and relevant. It has potential benefits for other stakeholders, notably teachers and patients. It can influence career choices.

Longitudinal associations between children's phonological processing abilities, ADHD-like behaviour ratings and early reading develpment

The current study examined the contribution of phonological processing abilities and ADHD-like behaviours to first-grade word reading ability. 136 children were tested at the beginning and end of first grade. At both times, teachers rated children on hyperactive, inattentive, and oppositional behaviour. Children were given tests of letter knowledge at T1 and tests of word reading, phonological sensitivity, phonological memory, rapid automatised naming, and vocabulary at T1 and T2. Regression analyses revealed that, of the behavioural measures, inattention made the strongest contribution to T2 reading, even after controlling for the effects of T1 reading, hyperactivity, and oppositional behaviour. Hyperactivity did not explain variance in T2 reading once the effect of inattention was controlled. Inattention predicted 4.7% independent variance in T2 word reading ability, even after the effects of T1 reading, vocabulary, and phonological processing were controlled. Although phonological processing predicted 9.3% independent variance in T2 word reading, even after the effects of reading, vocabulary, and inattention were controlled, the effects of phonological processing may have been partly mediated by inattention. This research indicates that inattention contributes to the prediction of early reading development in unselected populations, and that this influence is independent of other key cognitive predictors of reading ability.

Early intervention for children and their parents following paediatric accidental injury

This study was undertaken to develop and evaluate the efficacy of an early intervention for children who had been injured in an accident. The aim of the intervention was to prevent the development of longterm psychological consequences. Brochures were developed for children, adolescents, and their parents. These brochures detailed common responses to trauma (and normalized such responses), and suggestions for minimizing any post-trauma distress. Participants were children aged 7-15 admitted to hospital for traumatic injury. The intervention was delivered to one of two hospitals, within 72 hours of the trauma. 103 children and parents participated in the study. The parents and children completed structured interviews and questionnaires 2 weeks, 4-6 weeks and 6 months post-trauma. Outcome analyses also indicated that the intervention reduced parental distress at 4-6 weeks post-trauma. The intervention did not impact significantly on child adjustment over this time period. Results of the 6 month follow-up suggested that the intervention resulted in an amelioration of child anxiety from one to six months post-trauma, whereas the controls exhibited an increase in anxiety over this time period. Overall, it was concluded that the early intervention is a simple, practical, and cost-effective method of reducing child and parent distress post-trauma.

Trade union policy and new technology: the Civil and Public Services Association

The introduction of a micro-electronic based technology to the workplace has had a far reaching and widespread effect on the numbers and content of jobs. The importance of the implications of new technology were recognised by the trade unions, leading to a plethora of advice and literature in the late 70s and early 80s, notably the TUC 'Technology and Employment ' report. However, studies into the union response have consistently found an overall lack of influence by unions in the introduction of technology. Whilst the advent of new technology has coincided with an industrial relations climate of unprecedented hostility to union activity in the post-war period, there are structural weaknesses in unions in coming to terms with the process of technological change. In particular was the identification of a lack of suitable technological expertise. Addressing itself to this perceived weakness of the union response, this thesis is the outcome of a collaborative project between a national union and an academic institution. The thesis is based on detailed case studies concerning technology bargaining in the Civil Service and the response of the Civil and Public Services Associations (CPSA), the union that represents lower grade white collar civil servants. It is demonstrated that the application of expertise to union negotiators is insufficient on its own to extend union influence and that for unions to effectively come to terms with technology and influence its development requires a re-assessment across all spheres of union activity. It is suggested that this has repercussions for not only the internal organisation and quality of union policy formation and the extent, form and nature of collective bargaining with employer representatives, but also in the relationship with consumer and interest groups outside the traditional collective bargaining forum. Three policy options are developed in the thesis with the 'adversarial' and 'co~operative' options representing the more traditional reactive and passive forms of involvement. These are contrasted with an 'independent participative' form of involvement which was a 'pro-active' policy option and utilised the expertise of the Author in the CPSA's response to technological change.

Review of progress in implementing the recommendations of Sir Gareth Roberts regarding employability and career development of PhD students and research staff:A report for Research Councils UK by an independent review panel October 2010

The need for improvement in the development of research careers and researchers’ training in transferable skills was highlighted in two particular recommendations (numbers 4.2 and 5.3) in the 2002 report ‘SET for success: the report of Sir Gareth Roberts’ Review - the supply of people with science, technology, engineering and mathematics skills’ (Roberts, 2002). As a consequence of that review, Research Councils UK (RCUK)1 have invested about £120 million, usually referred to as ’Roberts’ Money’, in research organisations to address this concern in all research disciplines. The last ‘Roberts’ Money’ payment will be for the period up to March 2011; it was therefore proposed to assess the progress made with taking forward these specific recommendations. An independent panel was formed by RCUK to undertake this review in 2010. The terms of reference for the panel are in Annex A. In summary, the panel was asked to review progress made and to advise RCUK and the higher education (HE) sector about future requirements for the development and training of researchers. In the course of their review, the panel considered a wide range of existing reports, interviewed key stakeholders in the HE sector and elsewhere, as well as drawing on their own knowledge and expertise. This report presents the findings of the panel’s review.